What is the Cow's (Calgary-Cambridge) score?

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Last updated: April 10, 2025View editorial policy

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From the Guidelines

The COWS score is a crucial tool for assessing opioid withdrawal severity, ranging from 0 to more than 36, with higher scores indicating more severe withdrawal, as outlined in the 2020 Annals of Emergency Medicine study 1. The COWS assessment includes evaluation of various symptoms such as:

  • Resting pulse rate
  • Sweating
  • Restlessness
  • Pupil size
  • Bone/joint aches
  • Runny nose/tearing
  • GI upset
  • Tremor
  • Yawning
  • Anxiety
  • Gooseflesh These symptoms are scored and categorized into different levels of severity, with scores of 5-12 indicating mild withdrawal, 13-24 moderate withdrawal, 25-36 moderately severe withdrawal, and scores above 36 severe withdrawal, as described in the study 1. The COWS score is particularly valuable because it provides an objective measure of withdrawal severity, allowing for consistent assessment across different healthcare providers and settings, which is essential for determining appropriate treatment interventions, including medication dosing for treatments like buprenorphine or methadone, as noted in the study 1. Key considerations for healthcare providers include:
  • Accurately assessing the severity of opioid withdrawal symptoms using the COWS score
  • Using the COWS score to guide treatment decisions, including medication selection and dosing
  • Regularly monitoring patients' COWS scores to adjust treatment plans as needed, as recommended in the study 1.

From the Research

Cows Score

There is no information available in the provided studies to determine a "cows score". The studies appear to be related to human health, antibiotics, and inflammation, with no mention of cows or any scoring system related to them.

  • The studies discuss various topics such as acute bronchitis 2, the Precautionary Principle in public health nursing 3, antibiotics as anti-inflammatory agents 4, anti-inflammatory activity of macrolide antibiotics 5, and therapies aimed at the gut microbiota and inflammation 6.
  • None of the studies provide any information that could be used to determine a "cows score".

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Acute Bronchitis: Rapid Evidence Review.

American family physician, 2025

Research

The Precautionary Principle, public health, and public health nursing.

Public health nursing (Boston, Mass.), 2008

Research

Antibiotics as anti-inflammatory agents.

Current opinion in investigational drugs (London, England : 2000), 2002

Research

Anti-inflammatory activity of macrolide antibiotics.

The Journal of pharmacology and experimental therapeutics, 2000

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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